Balsalazide therapy in ulcerative colitis

Balsalazide is a 5‐aminosalicylic acid (mesalazine) pro‐drug which has an inert carrier molecule instead of the sulfapyridine moiety of sulfasalazine. It is designed to deliver 5‐aminosalicylic acid to the colonic mucosa without the sulfapyridine‐associated side‐effects encountered with sulfasalazine. Several studies have confirmed the efficacy and patient tolerance of balsalazide. When compared to mesalazine at equivalent doses, it induced symptomatic and complete remission of acute ulcerative colitis in a greater proportion of patients. In particular, patients with resistant left‐sided disease were shown to have a higher probability of achieving remission. Balsalazide was beneficial in patients with troublesome nocturnal symptoms. It has a similar efficacy in maintaining remission when compared to sulfasalazine and mesalazine. The advantage of balsalazide over other 5‐aminosalicylic acid compounds is its superior patient tolerability with minimal side‐effects.